Structured Debriefing to Assess Performance of Entrustable Professional Activities.

The medical workplace presents challenges for workplace-based learning. Structured debriefing of shared clinical experiences has been proposed as a way to take advantage of workplace-based learning in a setting that facilitates deep learning conversations. To investigate faculty and learner acceptance of private, face-to-face, structured debriefing of performance of entrustable professional activities (EPAs).

Thrombotic Markers in Pregnant Patients with and without SARS-CoV-2 Infection.

Background: Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities and increased risk for venous and arterial thrombi. This study aimed to evaluate D-dimer levels and lupus anticoagulant (LAC) positivity in pregnant individuals with and without Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Study Design: This was a prospective cohort study of pregnant individuals delivering at a single academic institution from April 2020 to March 2022.

The predominant PAR4 variant in individuals of African ancestry worsens murine and human stroke outcomes.

Protease-activated receptor 4 (PAR4) (gene F2RL3) harbors a functional dimorphism, rs773902 A/G (encoding Thr120/Ala120, respectively) and is associated with greater platelet aggregation. The A allele frequency is more common in Black individuals, and Black individuals have a higher incidence of ischemic stroke than White individuals. However, it is not known whether the A allele is responsible for worse stroke outcomes.

NETosis induction reflects COVID-19 severity and long COVID: insights from a 2-center patient cohort study in Israel.

Background: COVID-19 severity and its late complications continue to be poorly understood. Neutrophil extracellular traps (NETs) form in acute COVID-19, likely contributing to morbidity and mortality.

Objectives: This study evaluated immunothrombosis markers in a comprehensive cohort of acute and recovered COVID-19 patients, including the association of NETs with long COVID.

Neutrophil cathepsin G proteolysis of protease-activated receptor 4 generates a novel, functional tethered ligand.

Platelet-neutrophil interactions regulate ischemic vascular injury. Platelets are activated by serine proteases that cleave protease-activated receptor (PAR) amino termini, resulting in an activating tethered ligand. Neutrophils release cathepsin G (CatG) at sites of injury and inflammation, which activates PAR4 but not PAR1, although the molecular mechanism of CatG-induced PAR4 activation is unknown.

COVID-19 and Sepsis Are Associated With Different Abnormalities in Plasma Procoagulant and Fibrinolytic Activity.

Objective: Coronavirus disease 2019 (COVID-19) is associated with derangement in biomarkers of coagulation and endothelial function and has been likened to the coagulopathy of sepsis. However, clinical laboratory metrics suggest key differences in these pathologies. We sought to determine whether plasma coagulation and fibrinolytic potential in patients with COVID-19 differ compared with healthy donors and critically ill patients with sepsis.

Neutrophil extracellular traps contribute to immunothrombosis in COVID-19 acute respiratory distress syndrome.

COVID-19 affects millions of patients worldwide, with clinical presentation ranging from isolated thrombosis to acute respiratory distress syndrome (ARDS) requiring ventilator support. Neutrophil extracellular traps (NETs) originate from decondensed chromatin released to immobilize pathogens, and they can trigger immunothrombosis. We studied the connection between NETs and COVID-19 severity and progression.

Left-sided congenital diaphragmatic hernia: can we improve survival while decreasing ECMO?

Background: Mortality and ECMO rates for congenital diaphragmatic hernia (CDH) remain ~30%. In 2016, we changed our CDH guidelines to minimize stimulation while relying on preductal oxygen saturation, lower mean airway pressures, stricter criteria for nitric oxide (iNO), and inotrope use. We compared rates of ECMO, survival, and survival without ECMO between the two epochs.

Deficient Neutrophil Extracellular Trap Formation in Patients Undergoing Bone Marrow Transplantation.

Overwhelming infection causes significant morbidity and mortality among patients treated with bone marrow transplantation (BMT) for primary immune deficiencies, syndromes of bone marrow failure, or cancer. The polymorphonuclear leukocyte (PMN; neutrophil) is the first responder to microbial invasion and acts within the innate immune system to contain and clear infections. PMNs contain, and possibly clear, infections in part by forming neutrophil extracellular traps (NETs).

Neonatal necrotizing enterocolitis: diagnosis, management, and pathogenesis.

The diagnosis of neonatal necrotizing enterocolitis is one of great concern to pediatric and neonatal clinicians. Intravenous access remains an integral part of the medical and surgical management of infants with this diagnosis, and the infusion nurse is intimately involved in the care of these patients. This article discusses the definition of necrotizing enterocolitis, presents current knowledge regarding its basic pathophysiology, and identifies common and rare sequelae of this oftentimes devastating disease of premature infants.

A consideration of neonatal resuscitation.

There are currently two major areas of resuscitation of the newborn which have come into question: the use of intermittent positive pressure ventilation and the use of oxygen. There is evolving evidence that volutrauma associated with IPPV, especially in the premature infant, may induce changes in the lung which can lead to chronic lung disease. There is reason to believe that the use of continuous positive airway pressure in premature infants who are making respiratory efforts may be less harmful than the use of IPPV.